Individual
CONNIE STACKHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4828 NELSON RD, LAKE CHARLES, LA 70605-5214
(337) 477-9068
Mailing address
2001 PLANTATION DR, LAKE CHARLES, LA 70605-5266
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
14020
LA
Other
Enumeration date
06/04/2012
Last updated
06/04/2012
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